ABOUT 3,000 AMERICANS DIE EACH YEAR FROM AN AORTIC DISSECTION

Bloomberg News (12/15, Lauerman, Waters) reports that "the torn aorta that led to the death of Richard Holbrooke, the U.S. envoy for Afghanistan and Pakistan, is an uncommon disorder that isn't always recognized, doctors said."

USA Today (12/15, Rubin) reports that approximately "3,000 Americans die each year from an aortic dissection, although the actual number probably is higher." USA Today adds that the book With Love and Laughter, by John Ritter's widow, Amy Yasbeck, "devotes chapter 24, titled 'From the Heart,' to the topic of aortic aneurysms. The chapter includes the 'Ritter Rules,' named for her late husband and based on new guidelines about the diagnosis and treatment of aortic aneurysms from the American Heart Association and the American College of Cardiology." The Los Angeles Times (12/14, Forgione) "Booster Shots" blog also covered the story.

META-ANALYSIS FINDS NO EXCESS RISK OF CANCER WITH ANY SINGLE ANTIHYPERTENSIVE DRUG

HeartWire (11/29, Nainggolan) reported that "a new meta-analysis of almost 325,000 individuals from 70 clinical trials has found no excess risk of cancer or cancer death with any single antihypertensive drug." These "results counter the conclusions of a review published earlier this summer...which indicated that angiotensin-receptor blockers (ARBs) were associated with a modest increased risk of developing cancer." But, "a statistically significant increase in cancers among patients taking an ARB in combination with an ACE inhibitor of roughly 10% means the authors 'cannot rule out' an increased risk of cancer with the combination of these two medications." The research is published in the Lancet Oncology.

BINGE DRINKING MAY INCREASE RISK FOR HEART ATTACK, HEART DISEASE

Bloomberg News (11/24, von Schaper) reports, "The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week," according to a study published Nov. 23 in the British Medical Journal. "Middle-aged men in Belfast had almost double the risk of developing heart disease, compared with French drinkers who spread their consumption over a week." Bloomberg News notes that the study "bolsters the findings of previous studies suggesting a link between ischemic heart disease...and drinking patterns."

WebMD (11/23, Hendrick) reported that after examining the "alcohol drinking patterns of 9,758 men in France and Belfast over a 10-year period," researchers found that "men who binge drink have nearly twice the risk of heart attack or death from heart disease than regular drinkers over a 10-year period." For study purposes, "binge drinking was defined as excessive alcohol consumption, or the equivalent of four or five drinks in a short period of time such as a weekend day."

HeartWire (11/23, Nainggolan) reported that an accompanying editorial noted, "Middle-aged men should be made aware that if they are irregular heavy drinkers, the possible cardioprotective properties of alcohol consumption may not apply to them, and in contrast they may be putting themselves at increased risk of having a heart attack." BBC News (11/24) also covers the story.

PROPOXYPHENE, ACETAMINOPHEN AND PROPOXYPHENE PAINKILLERS PULLED FROM MARKET OVER HEART RISKS AFTER FDA RECOMMENDATION

The Los Angeles Times (11/19, Zajac) reported, "The maker of Darvon [propoxyphene] and Darvocet [acetaminophen and propoxyphene] announced Friday that it will stop marketing the widely used painkillers in the US because of a new study linking the active ingredient in the drugs to serious and sometimes fatal heart rhythm abnormalities." Xanodyne Pharmaceuticals Inc. "agreed to the ban at the request of the Food and Drug Administration, which also asked makers of generic versions of the drugs' core compound, known as propoxyphene, to stop selling it in the US."

Bloomberg News (11/19, Peterson) reported Xanodyne "will withdraw Darvon and Darvocet, a product that combines Darvon's active ingredient with acetaminophen." The FDA "requested the move after evaluating study data, and asked makers of generic versions to take them off the market as well." Xanodyne's "new clinical research, combined with new epidemiological data, led the FDA to conclude that propoxyphene's benefits no longer outweigh its risks, said John Jenkins, director of the agency's Office of New Drugs."

The AP (11/19) reported, "Britain and the European Union decided to ban Darvon in 2005 and 2009, respectively, due to a long trend of suicides and accidental overdoses." The FDA said it "decided to take action based on a recent study showing Darvon interferes with the electrical activity of the heart, causing irregular heart rhythms that can be fatal. Xanodyne conducted the study last year at the government's request."

The Washington Post (11/19, Stein) reported, "The FDA has received two requests to remove the drug from the market since 1978 but had previously determined the benefits outweighed the risks." Consumer advocates "welcomed the announcement but sharply criticized the agency for failing to act sooner." The New York Times (11/19) "Prescriptions" blog, the Wall Street Journal (11/20, Dooren, subscription required), HeartWire (11/22), and the CNN (11/19) "The Chart" blog also reported the story.

VYTORIN MAY LOWER RISK OF HEART COMPLICATIONS IN PATIENTS WITH CKD

The New York Times (11/21, A25, Singer) reported, "Patients with chronic kidney disease (CKD) who took Vytorin [ezetimibe and simvastatin], a cholesterol-lowering pill, had one-sixth fewer heart attacks, strokes or operations to unblock their arteries than patients taking a placebo, according to" research presented during the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition. "The main benefit was not in reducing the risk of heart attacks and related deaths, but in reducing the artery operations and certain kinds of strokes," the Times added. The study's authors pointed out that "the difference in operations to unblock arteries -- 284 in the treated group compared with 352 in the placebo group -- was statistically significant."

"The trial was the largest ever on Vytorin," Bloomberg News (11/20, Cortez) reported. "Patients on the drug were 16 percent less likely to suffer a heart attack or stroke, need a procedure to clear arteries or die from heart disease than those given a placebo over five years." Based on these findings, Merck "said it will seek US approval to use the drug in" CKD patients.

The AP (11/21) reported, "The Oxford University study looked at more than 9,000 patients who had advanced or end-stage" CKD. According to Merck, "the result is significant because kidney patients have a high risk of vascular disease."

However, the "lipid-lowering therapy did not significantly affect progression of kidney disease, investigators reported," according to MedPage Today (11/20, Bankhead). "Renal outcomes in the trial included progression to end-stage renal disease (ESRD), ESRD or death, and ESRD or a twofold increase in serum creatinine level. The simvastatin/ezetimibe and placebo groups did not differ significantly in the rates of any renal endpoints," MedPage Today noted. The Wall Street Journal (11/22, Loftus, subscription required) and HeartWire (11/20, Wood) also covered the story.

SEEKING PROOF IN NEAR-DEATH CLAIMS

At 18 hospitals in the U.S. and U.K., researchers have suspended pictures, face up, from the ceilings in emergency-care areas. The reason: to test whether patients brought back to life after cardiac arrest can recall seeing the images during an out-of-body experience.

People who have these near-death experiences often describe leaving their bodies and watching themselves being resuscitated from above, but verifying such accounts is difficult. The images would be visible only to people who had done that.

"We've added these images as objective markers," says Sam Parnia, a critical-care physician and lead investigator of the study, which hopes to include 1,500 resuscitated patients. Dr. Parnia declined to say whether any have accurately described the images so far, but says he hopes to report preliminary results next year.

The study, coordinated by Southampton University's School of Medicine in England, is one of the latest and largest scientific efforts to understand the mystery of near-death experiences.

At least 15 million American adults say they have had a near-death experience, according to a 1997 survey—and the number is thought to be rising with increasingly sophisticated resuscitation techniques.

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iStockphoto

People often describe moving down a dark tunnel toward a bright light after a near death experience.

Dead or Alive?

An analysis of 613 near-death experiences gathered by the Near Death Research Foundation found:

• About 75% included an out-of-body experience
• 76% reported intense positive emotions
• 34% described passing through a tunnel
• 65% described encountering a bright light
• 22% had a life review
• 57% encountered deceased relatives or other beings

Note: Patients could report more than one sensation.

In addition to floating above their bodies, people often describe moving down a dark tunnel toward a bright light, feeling intense peace and joy, reviewing life events and seeing long-deceased relatives—only to be told that it's not time yet and land abruptly back in an ailing body.

The once-taboo topic is getting a lot of talk these days. In the new movie "Hereafter," directed by Clint Eastwood, a French journalist is haunted by what she experienced while nearly drowning in a tsunami. A spate of new books details other cases and variations on the theme.

Yet the fundamental debate rages on: Are these glimpses of an afterlife, are they hallucinations or are they the random firings of an oxygen-starved brain?

"There are always skeptics, but there are millions of 'experiencers' who know what happened to them, and they don't care what anybody else says," says Diane Corcoran, president of the International Association for Near-Death Studies, a nonprofit group in Durham, N.C. The organization publishes the Journal of Near-Death Studies and maintains support groups in 47 states.

Dr. Corcoran, a retired Army colonel who heard wounded soldiers talk of such experiences as a nurse in Vietnam, says many military veterans have had near-death experiences but are particularly hesitant to talk them for fear of being branded psychologically disturbed.

Some investigators say the most remarkable thing about near-death reports is that the core elements are the same, among people of all cultures, races, religions and age groups, including children as young as 3 years old.

In his new book, "Evidence of the Afterlife," Jeffrey Long, a radiation oncologist in Louisiana, analyzes 613 cases reported on the website of his Near Death Research Foundation and concludes there is only one plausible explanation: "that people have survived death and traveled to another dimension."

Skeptics say there is no way to verify such anecdotal reports—and that many of the experiences can be explained by neurobiological changes in the brain as people die.

In the 1980s, British neuroscientist Susan Blackmore theorized that oxygen deprivation was to blame and noted that fighter pilots also encountered tunnel vision and hallucinations at high altitudes and speeds.

This year, a study of 52 cardiac-arrest patients in Slovenia, published in the Journal of Critical Care, found that the 21% who had near-death experiences also had high blood levels of carbon dioxide, which has been associated with visions, bright lights and out-of-body experiences.

A study of seven dying patients at George Washington University Medical Center, published in the Journal of Palliative Medicine, noted that their brainwaves showed a spurt of electrical activity just before they were pronounced dead. Lead investigator Lakhmir Chawla, an intensive-care physician, notes that the activity started in one part of the brain and spread in a cascade and theorized that it could give patients vivid mental sensations.

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Warner Bros. Pictures

Matt Damon, left, plays a psychic in the movie 'Hereafter,' which explores themes of the afterlife.

Some scientists have speculated that the life review some patients experience could be due to random activation of the dying brain's memory circuits. The sensation of moving down a tunnel could be due to long-buried birth memories suddenly retrieved. The feeling of peace could be endorphins released during extreme stress.

Other researchers say they have produced similar experiences by stimulating neurons in parts of the brain—or by giving patients ketamine, a tranquilizer and sometime party drug.

Yet researchers who have studied near-death experiences note that such experiments tend to produce only fragmentary visions and hallucinations, not the consistent, lucid and detailed accounts of events that many resuscitated patients report. One study found that people who had near-death experiences had higher blood oxygen levels than those who didn't.

Several follow-up studies have found that people undergo profound personality changes after near-death experiences—becoming more altruistic, less materialistic, more intuitive and no longer fearing death. But some do suffer alienation from spouses or friends who don't understand their transformation.

Other relatives understand all too well.

Raymond Moody, who first coined the term near-death experience in his 1975 book "Life After Life," explores the even stranger phenomenon of "shared death experiences" in a new book, "Glimpses of Eternity." He recounts stories of friends, family and even medical personnel who say they also saw the light, the tunnel and accompanied the dying person partway on his or her journey. "It's fairly common among physicians who are called to resuscitate someone they don't know—they say they've seen a spirit or apparition leave the body," says Dr. Moody.

Meanwhile, in his book, "Visions, Trips and Crowds," David Kessler, a veteran writer on grief and dying, reports that hospice patients frequently describe being visited by a deceased relative or having an out-of-body experience weeks before they actually die, a phenomenon called "near-death awareness." While some skeptics dismiss such reports as hallucinations or wishful thinking, hospice workers generally report that the patients are otherwise perfectly lucid—and invariably less afraid of death afterward.

Mr. Kessler says his own father was hopeless and very sad as he was dying. "One day, he had an amazing shift and said, 'Your mother was here—she told me I'd be dying soon and it will be fine—everyone will be there."

Dr. Parnia, currently an assistant professor of critical care at State University of New York, Stony Brook, says verifying out-of-body experiences with pictures on the ceiling is only a small part of his study. He is also hoping to better understand whether consciousness exists apart from the brain and what happens to it when the brain shuts down. In near-death experiences, people report vivid memories, feelings and thought processes even when there is no measurable brain activity.

"The self, the soul, the psyche—throughout history, we've never managed to figure out what it is and how it relates to the body," he says. "This is a very important for science and fascinating for humankind."

More Information

* International Association of Near-Death Studies
* Near-Death Research Foundation
* "The Big Book of Near-Death Experiences" by P.M.H. Atwater
* "Consciousness Beyond Life: The Science of the Near-Death Experience" by Pim Van Lommel
* "Evidence of the Afterlife" by Jeffrey Long and Paul Peery
* "Glimpses of Eternity" by Raymond Moody and Paul Perry
* "Visions, Trips and Crowded Rooms: Who and What You See Before You Die" by David Kessler
* "Heaven: Our Enduring Fascination With the Afterlife" by Lisa Miller



October 25, 2010; Wallstreet Journal, Health Journal

POSTED BY STEVEN ALMANY, MD

THE DOCTOR WILL SEE YOU EVENTUALLY

Of all the problems with the U.S. health-care system, one of the most vexing for patients is simply sitting in the doctor's waiting room. Being ushered into the exam room, only to be left shivering in a paper gown, to wait some more, adds to the aggravation. It's the health-care equivalent of being stuck on the tarmac in a crowded plane.

The average time patients spend waiting to see a health-care provider is 22 minutes, and some waits stretch for hours, according to a 2009 report by Press Ganey Associates, a health-care consulting firm, which surveyed 2.4 million patients at more than 10,000 locations. Orthopedists have the longest waits, at 29 minutes; dermatologists the shortest, at 20. The report also noted that patient satisfaction dropped significantly with each five minutes of waiting time.

Physicians rightly bristle that they aren't serving french fries. Patients are different, and their needs are unpredictable. What's more, doctors say that fee-for-service medicine with low reimbursement rates forces them to keep packing more patients into each day, compounding the opportunity for delays.

"I live my life in seven-minute intervals," says Laurie Green, a obstetrician-gynecologist in San Francisco who delivers 400 to 500 babies a year and says she needs to bring in $70 every 15 minutes just to meet her office overhead.

Some practices, like Dr. Green's, pride themselves on running efficiently, and others are finding ways to streamline office-traffic flow and cut waiting time. "Patients' time is valuable. I think practitioners understand that more and more," says Andre W. Renna, executive director of a group of 14 gastroenterologists in Lancaster, Pa. He says even the term "waiting room" has a bad connotation. Many offices prefer "reception area" instead.

Some steps to reduce patient wait times are as simple as leaving a few "catch-up" slots empty each day or stocking the same supplies in the same place in every exam room. "That way, doctors don't have to stick their heads out the door and ask where things are. It saves a lot of time," says L. Gordon Moore, a family physician and faculty member of the Institute for Healthcare Improvement, a Cambridge, Mass.-based non-profit group that advises medical practices.

Cutting waiting times is also part of the movement toward turning primary-care practices into what reformers call "patient-centered medical homes."

For now, patients themselves can minimize waits by asking for the first appointment of the day or right after lunch, when doctors are least likely to be backed up.

Measures the health-care industry is trying or reviewing include:

"Open-access" scheduling: Doctors used to think that having their appointments booked weeks in advance was a mark of prestige. It can also make for delays. Patients scheduled far in advance often cancel or fail to show. So offices, like airlines, tend to overbook, then struggle to fit everyone in.

"Those things have ripple effects, and the barometer is the waiting room," says Terry McGeeney, president and CEO, of TransforMED, a subsidiary of the American Academy of Family Physicians (AAFP) working to improve medical-practice design.

Instead, the AAFP and other primary-care groups now urge practices to leave as much as 70% of their schedules open for same-day appointments. Patients with immediate concerns are more likely to show up, on time, and stick to the point. "When patients think they may not be back in for a few months, they have a tendency to say, 'Can we also talk about this other thing?' so what should have been a 15-minute appointment ends up to being 30," Dr. McGeeney says.

Efficient offices also monitor their ebbs and flows in patient traffic and leave more slots open, say, on Mondays and Fridays and during flu season.

Switching to open-access scheduling can take months of transition time, and some doctors worry that appointment slots will go unfilled. "But the reality is you have the same number of patients and the same number of problems," says Dr. McGeeney. "And over time, patients flow through the office much more quickly."

Minimize office visits: Many follow-up doctor visits could easily be handled via phone, email or video chat. But in the past, doctors had to have patients return to the office in order to get reimbursed for their time and expertise. Now some insurers are beginning to cover nontraditional visits, including phone consultations in some circumstances. "I think we'll even get to the point where we'll have some of these visits by smartphone," says Douglas Wood, chairman of health-care policy and research at the Mayo Clinic in Rochester, Minn.

Advance prep: Having patients complete registration forms, medication lists and other paperwork in advance, via computer or mail, can also speed office visits considerably. So does having a receptionist or nurse make sure that all necessary test results and records have been received before the patient arrives.
Self Scheduling

Some pilot programs even let patients schedule their own visits via computer, minimizing overbooking and making patients more aware of a doctor's time constraints. "Some patients say, 'Hey, it's getting close to 11:30. I better wrap it up,'" Dr. Moore says.

Huddling up: Some of the unpredictability practices face actually is predictable if practices know their patients well.

"Here's Mr. So and So. He's in a 15-minute slot, but we know he's a 45-minute guy," says Dr. Moore. "Or Mrs. Jones is bringing in a kid with a sore throat. But we know she always brings in the other three."

By reviewing the upcoming patient list several times a day, doctors and other staffers can anticipate and plan around some delays.

Teamwork: Many primary-care physicians spend much of the day doing tasks that other staffers could do, experts say. If the practice is big enough, nurse practitioners, medical assistants and other "physician extenders" could handle many aspects of patient care and cut waiting time, while the doctor is busy elsewhere. "In my office, everyone has a flu shot before I even get in the room," says Melissa Gerdes, a family physician in Whitehouse, Texas, who was part of a TransforMED pilot project.

Cutting "cycle time": In medical jargon, "cycle time" refers to the period from when a patient first arrives at the office until departure. Many practices are making a point to measure and reduce it. In Dr. Gerdes's demonstration project, patients themselves were given clipboards to record each phase of the visit, from when they arrived at the office, time in the waiting and exam rooms, time with the physician and time checking out. By identifying bottlenecks, she and her colleagues were able to cut about 12 minutes from the typical 40 minutes per hour.

"It did two things. It taught us how we were doing, but it also communicated to the patients that we were serious about improving," Dr. Gerdes says.

Keep patients informed: Simply keeping waiting patients informed about delays—and giving them the option to reschedule—can also go a long way. "It's just like sitting on an airplane—you want the pilot to tell you what's going on and what to expect," says Roland Goertz, president of the AAFP.
Tracking Apps

To that end, some practices now use automated programs to notify patients when they're behind schedule, even before patients get to the office. One Web-based tool, called MedWaitTime, lets patients check how late the doctor is running, much like airline passengers can get a flight-update. But it does require office staffers to manually update the information.

How we doing? Experts urge practices to periodically survey their patients to find out what they think about the office's efficiency. A simple note card asking them to rate aspects of the visit can yield some surprising insights.

A program called HowsYourHealth.org, designed by Dartmouth Medical School professor John H. Wasson, provides a detailed online questionnaire for patients to evaluate doctors' practices and give more detailed information about their own that can be integrated into the offices' electronic-medical records. The system, which is free for patients and a nominal $350 for practices, also allows doctors to compare their office scores with national averages and share ideas with other practices.

"It's really a combination of common sense, mathematics and eliminating stupid practices," Dr. Wasson says.
OCTOBER 19, 2010 Wallstreet Journal; Health Journal

EFFECTS OF DIET AND PHYSICAL ACTIVITY INTERVENTIONS

Date Posted: October 12, 2010
Authors: Goodpaster BH, DeLany JP, Otto AD, et al.
Citation: JAMA 2010;Oct 9:[Epub ahead of print].



Question:
What are the effects of weight loss and physical activity intervention on the adverse health risks of severe obesity?

Methods:
A single-blind randomized trial was conducted from February 2007 through April 2010 at the University of Pittsburgh. Participants were 130 (37% African American) severely obese (class II or III) adult participants without diabetes recruited from the community. Patients were provided a 1-year intensive lifestyle intervention consisting of diet and physical activity. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention, but with physical activity delayed for 6 months. Primary outcome was change in weight. Secondary outcomes were additional components comprising cardiometabolic risk, including waist circumference, abdominal adipose tissue, and hepatic fat content.

Results:
There was no difference between groups for: mean age 46 years, 10% men, mean body mass index 43.5 kg/m2, and 75% had class III obesity. Of 130 participants randomized, 101 (78%) completed the 12-month follow-up assessments. Although both intervention groups lost a significant amount of weight at 6 months, the initial-activity group lost significantly more weight in the first 6 months compared with the delayed-activity group (10.9 kg, 95% confidence interval [CI], 9.1-12.7 vs. 8.2 kg, 95% CI, 6.4-9.9; p = 0.02 for group × time interaction). Weight loss at 12 months, however, was similar in the two groups (12.1 kg, 95% CI, 10.0-14.2 vs. 9.9 kg, 95% CI, 8.0-11.7; p = 0.25 for group × time interaction). Waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups. The addition of physical activity promoted greater reductions in waist circumference and hepatic fat content.

Conclusions:
Among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favorable changes in cardiometabolic risk factors.

Perspective:
The findings are intuitive. Experience in our center is that patients who commit to both exercise and diet do better with weight loss and metabolic parameters, at least in part because of improved diet compliance in those who exercise

WOMEN WITH DEMANDING JOBS 40% MORE LIKLEY TO HAVE HEART ATTACK, STROKE

The CBS Evening News (11/14, story 11, 0:20, Mitchell) reported, "Findings of the longest major study on stress in women are in this evening. The 10-year study found women with demanding jobs were 40% more likely to have a heart attack or stroke as women with less stressful jobs."

The AP (11/14) reported that the study presented at the American Heart Association conference on Nov. 14 followed "17,415 participants in the Women's Health Study" for 10 years. The investigators then discovered that "women with demanding jobs and little control over how to do them were nearly twice as likely to have suffered a heart attack as women with less demanding jobs and more control."

"Women with high-stress jobs face about 88 percent more risk of a heart attack than if they had low workplace strain," Bloomberg News (11/14, Lopatto) reported. The study authors "defined the stressful positions as those with demanding tasks and little authority or creativity," Bloomberg News noted. HealthDay (11/14, Gardner), the Los Angeles Times (11/14, Roan) "Booster Shots" blog, BBC News (11/15), CNN /Health.com (11/14, Harding), and the UK's Daily Mail (11/15, Borland) also covered the story.

TESTOSTERONE THERAPY IN WOMEN WITH CHRONIC HEART FAILURE

A Pilot Double-Blind, Randomized, Placebo-Controlled Study
JACC 10-10

Objectives:
The primary objective of this study was to assess the effect of a 6-month testosterone supplementation therapy on functional capacity and insulin resistance in female patients with chronic heart failure (CHF).
Background: Patients with CHF show decreased exercise capacity and insulin sensitivity. Testosterone supplementation improves these variables in men with CHF. No study has evaluated the effects of testosterone supplementation on female patients with CHF.

Methods:
Thirty-six elderly female patients with stable CHF, (ejection fraction 32.9 ± 6) were randomly assigned (2:1 ratio) to receive testosterone transdermal patch (T group, n = 24) or placebo (P group, n = 12), both on top of optimal medical therapy. At baseline and after 6 months, patients underwent 6-min walking test (6MWT), cardiopulmonary exercise test, echocardiogram, quadriceps maximal isometric voluntary contraction, dynamic quadriceps isokinetic strength (peak torque), and insulin resistance assessment by homeostasis model.

Results:
Distance walked at 6MWT as well as peak oxygen consumption significantly improved in the T group, whereas they were unchanged in the P group (p < 0.05 for all comparisons). The homeostasis model was significantly reduced in the T group in comparison with the P group (-16.5% vs. +5%, respectively; p < 0.05). Maximal voluntary contraction and peak torque increased significantly in the T group but did not change in the P group. Increase in distance walked at 6MWT was related to the increase in free testosterone levels (r = 0.593, p = 0.01). No significant changes in echocardiographic parameters were observed in either group. No side effects requiring discontinuation of T were detected.

Conclusions:
Testosterone supplementation improves functional capacity, insulin resistance, and muscle strength in women with advanced CHF. Testosterone seems to be an effective and safe therapy for elderly women with CHF.